"Last man standing" - tracking the evolution of Plasmodium falciparum resistance against artemisinin-based combination therapy in East-Africa
This study aims to continue and deepen the temporal and spatial surveillance of selection of molecular markers associated with antimalarial drug resistance as an early warning system of evolution and spread of P. falciparum tolerance/resistance against ACT in Bagamoyo district, Tanzania, and Zanzibar.
In addition, the project will study if the efficacy, i.e. parasite clearance times (both by a novel real-time PCR based quantitative method and by microscopy) and PCR corrected cure rates, of artesunate-amodiaquine in Zanzibar and artemether-lumefantrine in Bagamoyo district, Tanzania, for treatment of uncomplicated P. falciparum malaria has been impaired by the selection of ACT tolerance/resistance markers that occurred in the respective parasite populations during a decade of wide-scale ACT use.
The data will provide improved understanding of the evolution of ACT resistance, and thus an opportunity for optimized surveillance strategies for ACT resistance.
Global malaria control relies substantially on sustained efficacy of artemisinin-based combination therapies (ACT), since no alternative antimalarial drugs with similar high efficacy are available. There are indications of declining susceptibility of P. falciparum to ACT, both from Africa with selection of molecular markers associated with resistance to the long acting partner drug in ACT as well as reports of artemisinin resistance from South-East Asia, phenotypically characterized as prolonged parasite clearance times.